As health services go, the British National Health Service is pretty safe. The laws protecting LGBTQ+ people are decent and there is, on the whole, a strong code of practice concerning the treatment of transgender people. On the whole. Trouble is, a 99.9% effective policy means 1 in 1,000 get mistreated and we know the policies are not that effective. Given the hundreds of thousands of transgender people that pass through the UK system, those aren’t good odds.
With this in mind, I’ve taken steps to control my information. I’m lucky in that I have a cooperative surgery that sees my requests as relevant to all of their patients rather than some kind of oddity. It’s not perfect but we’re working on it and I feel safer for knowing they are careful about sharing that specific detail about me.
Transgender people are one of the few groups that cannot take fair and reasonable treatment from medical staff for granted. Personally, I’m not so worried about being refused treatment or being abused by an individual, though that certainly happens. My fear is that they insist I go into a men’s ward or otherwise segregated from the other women when that would not normally be considered.
> “ANOTHER FEAR IS FOR SOME NURSE TO NOTICE I’M TRANSGENDER SOMEHOW AND ADD THAT TO MY NOTES IN THE HOSPITAL.”
Another fear is for some nurse to notice I’m transgender somehow and add that to my notes in the hospital. These things have a way of filtering into general record; all of my careful work with my doctors to keep my status on a need-to-know basis could be ruined by one overzealous health professional. There’s a perception that being transgender is automatically medically relevant to whatever treatment we’re receiving, be it pneumonia or a hip operation.
Certain things I have to admit are relevant. Sexual health, depending on the person, could be an area where it’s important to know someone’s transgender status. A person’s operative status is of particular note in that area: it will have an impact on what kinds of tests a person needs. Some routine testing, like smear tests, also require the context. That’s about it though, apart from endocrinology and even then, there are explanations. Most of the things we have to do to take care of ourselves don’t involve being transgender. The need-to-know circumstances are well defined and obvious.
Things potentially become more relevant with mental health. It depends on the individual’s relationship with gender. Gender tends to touch every part of our mental setup, but being transgender might not matter even if having a gender interact with your problems does. Like physical health, people love to make one’s transgender status important even when it isn’t, so best to leave it off and let it come up as and when it does.
So when the gender specialist sends along adjustments to my hormone treatment with the instruction to out me to the lab, I get upset. When their justification is something vague and unprovable, it gets even more upsetting. When their expanded explanation is a repetition of the note, then I lose faith that they’re actually thinking about what they’re doing.
In my particular case, the instruction was to out me to the lab or they wouldn’t do a complete hormone profile. This is a thing my GP had no problems obtaining in the two years I’ve been on hormone therapy, so the instruction is confusing. That I’m transgender is medically relevant in a global sense, but in the specific it isn’t. The relevance is that I’m on certain medication that requires monitoring. Nobody really needs to know why I’m on that medication but my GP, and I’m strongly motivated to keep it from spreading.
Some folks will be reading this thinking, “She’s worrying too much.” I probably am, but this is where my boundaries are at the moment. I might stop caring at some point, or I might care even more. My boundaries with my information have changed so much in the last year, I’ve stopped questioning. I just act on what feels right, and keeping the medical system on a need-to-know basis feels right.
After a meeting with my habitual GP to discuss the bizarre instruction, she agreed with me that it was an odd statement to make. She also agreed to put a note on my file denying any future requests of that nature, so again, I’m lucky. We can’t take the cooperation of medical staff for granted, and I’m grateful to whatever star I was born under to have the support I do.
> “IT’S SAD AND FRIGHTENING THAT GOING TO THE DOCTOR IS A POTENTIAL DANGER FOR TRANSGENDER PEOPLE.”
It’s sad and frightening that going to the doctor is a potential danger for transgender people. It’s disturbing that I should feel the need to keep my information so tightly controlled; the medical system and the people who keep it going are people we are taught to trust. Unlearning that trust was a traumatic process, but too many connected to me have been mistreated.
Distrust of the medical system stems from a general loss of faith in agencies: police, government offices, charities, businesses. The basic structures that hold modern society together often fail transgender people and the damage, even when one escapes relatively unscathed, is catastrophic. Society as an institution teaches us we’re unwanted objects of contempt. We are denied the safety it creates — its purpose for existing in the first place.
I can’t just go to any doctor, I have to go to the doctor I’ve learned is safe. The only way to learn is to keep trying new ones until one doesn’t hurt me. It’s stranger danger on a culture-wide scale. And maybe I seem alarmist at least, paranoid at most, but until I feel safe, my information will remain closely guarded. The specialists available to me appear blind, unthinking and uncooperative. That tells me it will be a very long time before any of us are safe.